DOI: 10.36347/sjmcr.2016.v04i11.010

Pages: 837-841

A 48-year-old retired army personnel presented to us with the complaint of sudden onset painless loss of vision in left eye for three days. He also gave a history of severe migraine attacks mainly affecting left temporal area. He had no other co-morbidities, was a non-smoker and denied any history of head and neck trauma. Clinical examination revealed vision in the left eye was no perception to light with Marcus Gunn pupil. IOP was 18mmHg. Fundoscopy revealed a pale optic disc and retina, attenuation of retinal arteries and the typically described cherry red spot sign. Right eye examination was unremarkable, with 6/6 vision. Systemic examination revealed BP of 112/67mmHg, no cardiac murmurs and absent carotid bruit. Blood and imaging studies were performed to determine the underlying cause of CRAO. These include screening for diabetes, dyslipidemia, valvular or cardiac wall abnormalities, vasculitis, coagulopathies and carotid artery stenosis. The blood investigation results revealed that the patient was dyslipidemic. The carotid Doppler demonstrated a total occlusion of left internal carotid artery possibly due to undetected dyslipidemia. An urgent vascular referral was done, and CT carotid angiography confirmed a total obliteration of the left internal carotid artery at the bifurcation of the common carotid artery. Endarterectomy was not required and he was treated conservatively with aspirin and statins.